Using Electronic Health Record and Administrative Data to Analyze Maternal and Neonatal Delivery Complications

摘要

Background: Obstetric quality of care measures have largely focused on severe maternal morbidity (SMM), with littleconsensus about measures of less severe but more prevalent delivery and neonatal complications. This study analyzes riskadjustedmaternal and neonatal outcomes using both ICD-10 coding and electronic health record (EHR) data.Methods: Complication rates at seven health system hospitals from January 2016 to August 2019 were analyzed. EHRdata and ICD-10 codes were used to identify the incidence of SMM as well as other route-specific maternal and neonatalcomplications. Researchers tested the association of maternal sociodemographic and clinical risk markers with the likelihoodof maternal and neonatal complications using multiple logistic and Poisson regression.Results: Among 42,681 deliveries, the SMM rate was 1.3%, and other complication rates were 12.9% for vaginal and19.7% for cesarean deliveries. The neonatal complication rate was 20.2%. Risk factors for all complications included multiplegestation and hypertensive disorders of pregnancy. Risk factors for SMM included nulliparity, cesarean delivery, and pre-existing conditions; risks for neonatal complications included academic medical center admission, cesarean delivery, highermaternal body mass index, and preterm birth. There were significant racial disparities in maternal and neonatal outcomes.Conclusion: This study is among the first to combine HER and administrative discharge data to describe a wide range ofmaternal and neonatal birth outcomes, including associations with established risk factors. Although SMM was rare, route-specific and neonatal complications were much more common and may offer a better focus for obstetric quality improvementefforts.